1. Charcot foot, or neuropathic osteoarthropathy, is a progressive condition characterized by joint destruction and instability associated with peripheral neuropathy.
2. It results from repetitive microtrauma to joints from loss of sensation and proprioception, as well as autonomic dysfunction leading to hyperemia and bone resorption.
3. Treatment involves complete offloading with non-weightbearing and immobilization to induce quiescence, followed by gradual protected weightbearing with custom bracing and accommodative footwear.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
TB of the spine commonly affects the thoracic and lumbar regions. It spreads hematogenously and causes destruction of vertebral bodies. Common presentations include chronic back pain and deformities. Advanced cases may involve neurological deficits due to spinal cord compression. Diagnosis involves imaging tests like x-rays and MRI. Treatment is with anti-TB medications along with rest. Surgery is indicated for complications like paraplegia. Prognosis depends on factors like age, duration of symptoms and severity of neurological involvement.
This document provides an overview of Legg Calve Perthes disease, including its definition, demographics, risk factors, pathogenesis, clinical features, investigations, classifications, management, and surgical procedures. Some key points:
- It is avascular necrosis of the femoral head in children, most common in ages 4-8 years. Positive family history and low birth weight are risk factors.
- Clinical features include hip/thigh pain aggravated by movement. Imaging shows stages from avascular necrosis to fragmentation to regeneration/healing.
- Conservative management includes bracing for young/mild cases. Surgical containment is used for more severe/older cases to encourage spherical remodeling.
- Procedures
Cubitus varus, or gunstock deformity, is caused by malunion of supracondylar fractures and results in the forearm being deviated inward at the elbow with loss of the carrying angle. It is a triplanar deformity involving varus, hyperextension, and internal rotation. Treatment options include observation for young children, hemiepiphysiodesis to alter growth, and corrective osteotomy. The lateral closing wedge osteotomy is commonly used to safely correct the varus deformity through removal of a lateral wedge. Other techniques include medial opening wedge, oblique, dome, and step-cut osteotomies. Postoperative management focuses on immobilizing the arm in extension
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
Bennett's fracture is a common intra-articular fracture of the base of the thumb metacarpal bone that extends into the carpometacarpal joint. It is usually caused by an axial force on a partially flexed thumb. Left untreated, it can lead to long-term pain, weakness, arthritis, and diminished hand function. While sometimes minimally displaced fractures can be treated non-surgically, surgical intervention like closed reduction or open reduction is often needed to ensure proper healing and restore thumb function. Long-term outcomes often include weakness and arthritis, with severity depending on how well the fracture was reduced.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
TB of the spine commonly affects the thoracic and lumbar regions. It spreads hematogenously and causes destruction of vertebral bodies. Common presentations include chronic back pain and deformities. Advanced cases may involve neurological deficits due to spinal cord compression. Diagnosis involves imaging tests like x-rays and MRI. Treatment is with anti-TB medications along with rest. Surgery is indicated for complications like paraplegia. Prognosis depends on factors like age, duration of symptoms and severity of neurological involvement.
This document provides an overview of Legg Calve Perthes disease, including its definition, demographics, risk factors, pathogenesis, clinical features, investigations, classifications, management, and surgical procedures. Some key points:
- It is avascular necrosis of the femoral head in children, most common in ages 4-8 years. Positive family history and low birth weight are risk factors.
- Clinical features include hip/thigh pain aggravated by movement. Imaging shows stages from avascular necrosis to fragmentation to regeneration/healing.
- Conservative management includes bracing for young/mild cases. Surgical containment is used for more severe/older cases to encourage spherical remodeling.
- Procedures
Cubitus varus, or gunstock deformity, is caused by malunion of supracondylar fractures and results in the forearm being deviated inward at the elbow with loss of the carrying angle. It is a triplanar deformity involving varus, hyperextension, and internal rotation. Treatment options include observation for young children, hemiepiphysiodesis to alter growth, and corrective osteotomy. The lateral closing wedge osteotomy is commonly used to safely correct the varus deformity through removal of a lateral wedge. Other techniques include medial opening wedge, oblique, dome, and step-cut osteotomies. Postoperative management focuses on immobilizing the arm in extension
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
Bennett's fracture is a common intra-articular fracture of the base of the thumb metacarpal bone that extends into the carpometacarpal joint. It is usually caused by an axial force on a partially flexed thumb. Left untreated, it can lead to long-term pain, weakness, arthritis, and diminished hand function. While sometimes minimally displaced fractures can be treated non-surgically, surgical intervention like closed reduction or open reduction is often needed to ensure proper healing and restore thumb function. Long-term outcomes often include weakness and arthritis, with severity depending on how well the fracture was reduced.
This document outlines the principles of amputation, including definitions, indications, types, pre-operative evaluation, operative techniques, post-operative care, and complications. It notes that amputation is an ancient procedure that should be viewed not as a failure of treatment, but as the first step towards allowing a patient to return to a more comfortable life. The document emphasizes the multidisciplinary nature of amputation and importance of both surgical and post-operative care in achieving the best outcomes for patients.
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
Jean-Martin Charcot first described neuropathic arthropathy in 1868. It is a progressive joint condition characterized by dislocations, fractures, and deformities that results from sensory or autonomic neuropathy from various conditions like diabetes, MS, alcoholism, etc. The pathophysiology involves both repetitive microtrauma from loss of sensation and an inflammatory process induced by neurovascular changes. It commonly affects the foot, knee, and hip. Diagnosis is made clinically and radiographically, showing features like joint destruction and deformity. Treatment involves casting, bracing, and surgery like fusion for advanced cases.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Intertrochanteric fractures of the femurRajiv Colaço
The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
supracondylar fracture humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow injuries in children, making up approximately 60% of cases. They typically occur as a result of a fall onto an outstretched hand in children aged 5-7 years old. Radiographs are used to classify fractures as non-displaced (Type I), displaced with an intact posterior cortex (Type II), or completely displaced (Type III). Posteromedial displacement is more common than posterolateral. Physical examination focuses on evaluating neurovascular status and detecting any S-shaped deformity, with nerve injuries occurring in up to 16% of cases.
This document provides information on peripheral nerve injuries, including the structure of nerves, classifications of nerve injuries, common sites of injury for specific nerves like the ulnar and radial nerves, clinical features of injuries, and treatment approaches. It details Seddon's and Sunderland's classifications of nerve injuries, which range from neurapraxia to neurotmesis depending on the severity of axonal and neural sheath damage. Specific injuries like ulnar nerve entrapment at the elbow or Guyon's canal are discussed. Both non-surgical and surgical treatment options are presented.
This document discusses meniscus injuries of the knee. It describes the anatomy and functions of the medial and lateral meniscus. Common types of meniscal tears are described based on location and pattern. Physical exam maneuvers for diagnosing meniscal tears include Thessaly test, McMurray's test, and Apley's grinding test. MRI is the most sensitive imaging method. Treatment involves initial rest, ice, and NSAIDs for minor tears. Surgery options include partial meniscectomy, meniscal repair, or meniscal transplantation for more severe tears. The goal of treatment is to relieve symptoms and prevent further joint damage.
This document discusses genu varum (bow legs), genu valgum (knock knees), and genu recurvatum (back bending knees). It covers the normal development and alignment of the lower limbs from birth through childhood. It describes the causes, presentations, and treatment options for physiological and pathological genu varum, genu valgum, and genu recurvatum, including observation, bracing, hemiepiphysiodesis (guided growth), and osteotomy. The goal of treatment is typically correction of the alignment through non-surgical or surgical means depending on the severity and cause of the deformity as well as the age and skeletal maturity of the patient.
Apply gentle pressure proximally
Surgeon: Check distal pulses and capillary refill
If no improvement:
Consider temporary arteriotomy or venous shunt
Delay closure and observe
Flap or graft may be needed
This document discusses neck of femur fractures (NOF), also known as hip fractures. It covers the epidemiology, risk factors, anatomy, classification, diagnosis, and treatment of NOF fractures. NOF fractures typically occur in elderly patients from low-energy falls and are associated with osteoporosis, while in younger patients they usually result from high-energy injuries. Treatment depends on factors like the patient's age, health, and fracture classification, and may involve closed or open reduction, fixation with screws or nails, or arthroplasty. Complications can include nonunion, osteonecrosis, fixation failure, dislocation, and increased mortality risk especially in older or less healthy patients.
Dr. Anshul Sethi discusses deformities around the knee joint, including genu varum, genu valgum, and genu recurvatum. Genu varum, also known as "bow legs", is an angular deformity with the knees pointing outward. It can be physiological in young children or pathological if present after age 2. Genu valgum or "knock knees" is an outward angulation of the femur and tibia. It is normal in children ages 3-4 with up to 20 degrees of valgus, but should not exceed 12 degrees after age 7. Genu recurvatum is hyperextension of the knee. The document covers causes, presentations, investigations, and
This document discusses Charcot foot, also known as neuropathic foot, which is a condition where repetitive stress causes destruction of bones and joints in the foot. It primarily affects those with nerve damage from conditions like diabetes, syphilis, tabes dorsalis, and leprosy. Charcot foot was first described by Jean-Martin Charcot in 1868. Physical findings include swelling, deformity, warmth, and bone resorption. Treatment involves immobilization in the acute phase to reduce stress, and bracing or surgery in the post-acute phase depending on the location and severity of damage. The document also briefly discusses the risks and management of diabetic foot complications.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
Loose bodies are fragments of bone or cartilage that float freely in the joint space, causing symptoms like knee pain, swelling, and locking. They are classified as stable or unstable. Individuals with joint diseases like arthritis are more at risk, as are athletes. Loose bodies are diagnosed by x-ray, CT, MRI or arthrography. Treatment options include NSAIDs, arthroscopic removal of large loose bodies, or open surgery. The focus of rehabilitation is controlling pain and restoring function through gait training and avoiding prolonged immobilization.
Osteomyelitis is an inflammatory process of bone caused by bacterial infection. It can be acute, subacute, or chronic depending on duration. The most common causative organism is Staphylococcus aureus. Acute osteomyelitis typically affects children and causes fever, pain, and swelling near the infected bone. Chronic osteomyelitis results from inadequate treatment of acute osteomyelitis and causes persistent infection, bone necrosis, and sinus tract formation. Surgical debridement along with long-term antibiotics is usually required to treat chronic osteomyelitis. Rehabilitation focuses on restoring range of motion and strength through exercises.
This document discusses Monteggia fractures, which involve a fracture of the ulna bone in the forearm combined with a dislocation of the radial head. It begins with a historical description of the injury and provides details on epidemiology and classifications. Bado's classification system from 1958 divides Monteggia fractures into four main types based on the direction of radial head dislocation and location of the ulna fracture. The document discusses mechanisms of injury, clinical evaluation, radiographic assessment, non-operative and operative management approaches, potential complications, and emphasizes the importance of anatomic reduction and stabilization of both the ulna fracture and radial head dislocation.
The document discusses the embryology of the upper limb and hand development. It notes that between 5-8 weeks of gestation is the critical period for limb development. The zones of polarizing activity and apical ectodermal ridge play important roles in directing growth. Thumb hypoplasia is often associated with radial deficiencies and other syndromes. The document covers classifications of thumb hypoplasia and radial deficiencies and discusses evaluation and treatment considerations.
The document discusses common wrist injuries including fractures of the scaphoid and hook of hamate bones, de Quervain's tenosynovitis, injuries to the distal radial epiphysis, triangular fibrocartilage complex tears, Kienböck's disease, carpal tunnel syndrome, and ulnar nerve compression. Many of these injuries occur due to falls on an outstretched hand or repetitive stresses from sports activities. Clinical exams and imaging tests can help diagnose specific injuries, which are often initially treated conservatively with rest, splinting, or injections but may require surgery in some cases.
This document outlines the principles of amputation, including definitions, indications, types, pre-operative evaluation, operative techniques, post-operative care, and complications. It notes that amputation is an ancient procedure that should be viewed not as a failure of treatment, but as the first step towards allowing a patient to return to a more comfortable life. The document emphasizes the multidisciplinary nature of amputation and importance of both surgical and post-operative care in achieving the best outcomes for patients.
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
Jean-Martin Charcot first described neuropathic arthropathy in 1868. It is a progressive joint condition characterized by dislocations, fractures, and deformities that results from sensory or autonomic neuropathy from various conditions like diabetes, MS, alcoholism, etc. The pathophysiology involves both repetitive microtrauma from loss of sensation and an inflammatory process induced by neurovascular changes. It commonly affects the foot, knee, and hip. Diagnosis is made clinically and radiographically, showing features like joint destruction and deformity. Treatment involves casting, bracing, and surgery like fusion for advanced cases.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Intertrochanteric fractures of the femurRajiv Colaço
The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
supracondylar fracture humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow injuries in children, making up approximately 60% of cases. They typically occur as a result of a fall onto an outstretched hand in children aged 5-7 years old. Radiographs are used to classify fractures as non-displaced (Type I), displaced with an intact posterior cortex (Type II), or completely displaced (Type III). Posteromedial displacement is more common than posterolateral. Physical examination focuses on evaluating neurovascular status and detecting any S-shaped deformity, with nerve injuries occurring in up to 16% of cases.
This document provides information on peripheral nerve injuries, including the structure of nerves, classifications of nerve injuries, common sites of injury for specific nerves like the ulnar and radial nerves, clinical features of injuries, and treatment approaches. It details Seddon's and Sunderland's classifications of nerve injuries, which range from neurapraxia to neurotmesis depending on the severity of axonal and neural sheath damage. Specific injuries like ulnar nerve entrapment at the elbow or Guyon's canal are discussed. Both non-surgical and surgical treatment options are presented.
This document discusses meniscus injuries of the knee. It describes the anatomy and functions of the medial and lateral meniscus. Common types of meniscal tears are described based on location and pattern. Physical exam maneuvers for diagnosing meniscal tears include Thessaly test, McMurray's test, and Apley's grinding test. MRI is the most sensitive imaging method. Treatment involves initial rest, ice, and NSAIDs for minor tears. Surgery options include partial meniscectomy, meniscal repair, or meniscal transplantation for more severe tears. The goal of treatment is to relieve symptoms and prevent further joint damage.
This document discusses genu varum (bow legs), genu valgum (knock knees), and genu recurvatum (back bending knees). It covers the normal development and alignment of the lower limbs from birth through childhood. It describes the causes, presentations, and treatment options for physiological and pathological genu varum, genu valgum, and genu recurvatum, including observation, bracing, hemiepiphysiodesis (guided growth), and osteotomy. The goal of treatment is typically correction of the alignment through non-surgical or surgical means depending on the severity and cause of the deformity as well as the age and skeletal maturity of the patient.
Apply gentle pressure proximally
Surgeon: Check distal pulses and capillary refill
If no improvement:
Consider temporary arteriotomy or venous shunt
Delay closure and observe
Flap or graft may be needed
This document discusses neck of femur fractures (NOF), also known as hip fractures. It covers the epidemiology, risk factors, anatomy, classification, diagnosis, and treatment of NOF fractures. NOF fractures typically occur in elderly patients from low-energy falls and are associated with osteoporosis, while in younger patients they usually result from high-energy injuries. Treatment depends on factors like the patient's age, health, and fracture classification, and may involve closed or open reduction, fixation with screws or nails, or arthroplasty. Complications can include nonunion, osteonecrosis, fixation failure, dislocation, and increased mortality risk especially in older or less healthy patients.
Dr. Anshul Sethi discusses deformities around the knee joint, including genu varum, genu valgum, and genu recurvatum. Genu varum, also known as "bow legs", is an angular deformity with the knees pointing outward. It can be physiological in young children or pathological if present after age 2. Genu valgum or "knock knees" is an outward angulation of the femur and tibia. It is normal in children ages 3-4 with up to 20 degrees of valgus, but should not exceed 12 degrees after age 7. Genu recurvatum is hyperextension of the knee. The document covers causes, presentations, investigations, and
This document discusses Charcot foot, also known as neuropathic foot, which is a condition where repetitive stress causes destruction of bones and joints in the foot. It primarily affects those with nerve damage from conditions like diabetes, syphilis, tabes dorsalis, and leprosy. Charcot foot was first described by Jean-Martin Charcot in 1868. Physical findings include swelling, deformity, warmth, and bone resorption. Treatment involves immobilization in the acute phase to reduce stress, and bracing or surgery in the post-acute phase depending on the location and severity of damage. The document also briefly discusses the risks and management of diabetic foot complications.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
Loose bodies are fragments of bone or cartilage that float freely in the joint space, causing symptoms like knee pain, swelling, and locking. They are classified as stable or unstable. Individuals with joint diseases like arthritis are more at risk, as are athletes. Loose bodies are diagnosed by x-ray, CT, MRI or arthrography. Treatment options include NSAIDs, arthroscopic removal of large loose bodies, or open surgery. The focus of rehabilitation is controlling pain and restoring function through gait training and avoiding prolonged immobilization.
Osteomyelitis is an inflammatory process of bone caused by bacterial infection. It can be acute, subacute, or chronic depending on duration. The most common causative organism is Staphylococcus aureus. Acute osteomyelitis typically affects children and causes fever, pain, and swelling near the infected bone. Chronic osteomyelitis results from inadequate treatment of acute osteomyelitis and causes persistent infection, bone necrosis, and sinus tract formation. Surgical debridement along with long-term antibiotics is usually required to treat chronic osteomyelitis. Rehabilitation focuses on restoring range of motion and strength through exercises.
This document discusses Monteggia fractures, which involve a fracture of the ulna bone in the forearm combined with a dislocation of the radial head. It begins with a historical description of the injury and provides details on epidemiology and classifications. Bado's classification system from 1958 divides Monteggia fractures into four main types based on the direction of radial head dislocation and location of the ulna fracture. The document discusses mechanisms of injury, clinical evaluation, radiographic assessment, non-operative and operative management approaches, potential complications, and emphasizes the importance of anatomic reduction and stabilization of both the ulna fracture and radial head dislocation.
The document discusses the embryology of the upper limb and hand development. It notes that between 5-8 weeks of gestation is the critical period for limb development. The zones of polarizing activity and apical ectodermal ridge play important roles in directing growth. Thumb hypoplasia is often associated with radial deficiencies and other syndromes. The document covers classifications of thumb hypoplasia and radial deficiencies and discusses evaluation and treatment considerations.
The document discusses common wrist injuries including fractures of the scaphoid and hook of hamate bones, de Quervain's tenosynovitis, injuries to the distal radial epiphysis, triangular fibrocartilage complex tears, Kienböck's disease, carpal tunnel syndrome, and ulnar nerve compression. Many of these injuries occur due to falls on an outstretched hand or repetitive stresses from sports activities. Clinical exams and imaging tests can help diagnose specific injuries, which are often initially treated conservatively with rest, splinting, or injections but may require surgery in some cases.
Neuropathic arthropathy, also known as Charcot arthropathy, is a condition characterized by progressive joint destruction and deformity caused by loss of sensation in the joints. It is most commonly seen in patients with diabetes or neurological disorders. The main theories for its pathophysiology are neurotrauma from repetitive micro-injuries without pain perception, and neurovascular changes that increase bone resorption. Treatment involves initial casting to immobilize the joint, followed by bracing, orthotics, and immobilization over the course of 1-2 years to allow healing. Surgical options like fusion or reconstruction may be used for advanced cases or deformity correction.
This document provides an overview of carpal instability, including:
1) Carpal instability occurs when an injury to a carpal ligament renders the wrist unstable as the carpal bones no longer move together properly.
2) Clinical presentation includes pain with wrist motion and tenderness over ligaments. Imaging can detect abnormal bone positioning or arthritis. Arthroscopy is the gold standard for diagnosis.
3) Risk factors include falls on an outstretched hand or high-energy trauma. Differential diagnosis includes tendonitis and nerve issues. Red flags include persistent pain after fracture healing or neurologic symptoms.
Spondylisthesis by dr venkata rama krishnaiah vapms copvrkv2007
Spondylolisthesis is the slippage of one vertebra over another. It is classified into six types based on cause, including dysplastic (congenital), isthmic, degenerative, traumatic, pathological, and iatrogenic. Isthmic spondylolisthesis is most common, typically occurring at L5-S1, and is often caused by a stress fracture of the pars interarticularis. Diagnosis involves x-rays and sometimes CT or MRI. Treatment includes rest, medications, bracing, physical therapy, and sometimes surgery to stabilize and fuse the vertebrae. Physical therapy focuses on core strengthening, stretching, and exercises to improve mobility and reduce pain.
The Lisfranc joint was named after a field surgeon who described an amputation through the joint due to gangrene from an injury sustained after a soldier fell from a horse. Lisfranc injuries account for less than 1% of fractures and can result from high-energy trauma or less stressful twisting injuries. Diagnosis can be difficult as swelling and pain in the midfoot region are often the only findings. Treatment involves immobilization for mild sprains but surgery within 1-2 days for fractures or dislocations to ensure proper healing and prevent long-term disability. Surgical techniques include open reduction and internal fixation to anatomically realign the bones which allows for better functional outcomes compared to fusion or casting.
This document discusses biological treatment options for avascular necrosis (AVN) of the femoral head. It provides details on the anatomy and blood supply of the femoral head. AVN occurs when there is interruption of blood flow to the femoral head, leading to bone cell death. Imaging plays an important role in diagnosis and staging of AVN. Conservative options include restricted weight bearing, medications, and physical therapies. Surgical options become necessary with more advanced stages to prevent femoral head collapse. The document covers various classification and staging systems used to determine the appropriate treatment based on the individual case.
Arthritis and arthroplasty- dr. Mahmoud Abdel KareemAhmed-shedeed
This document provides information about osteoarthritis (OA), including its definition, prevalence, risk factors, pathology, diagnosis, natural history, differential diagnosis, and treatment. It notes that OA is the most common form of arthritis, affecting over 20 million people in the US. Risk factors include age, obesity, family history, and previous joint injury or disorder. Diagnosis is typically based on symptoms like pain and stiffness, physical exam findings, and x-ray evidence of cartilage loss, bone spurs, and bone changes. Treatment includes conservative options like medications, exercise, and weight loss, as well as intra-articular injections or surgery for advanced cases.
Imaging of foot in non trauma and non neoplastic diseasesShail Padmani
The document discusses the radiologic evaluation of the foot. It begins by describing the complex anatomy of the foot and various pathologies that can occur. It then discusses the sequence of ossification in the foot bones during fetal development. Various imaging modalities for evaluating the foot are described including radiography, ultrasound, CT, and MRI. Common congenital variants, abnormalities, tendon pathologies and other conditions involving the foot that can be assessed with imaging are outlined.
A 66-year-old male presented with non-specific lower back pain. MRI revealed disc degeneration including annular bulging and Schmorl's nodes in the upper lumbar spine. The diagnosis was lumbar spondylosis. Disc degeneration results from mechanical stress and age-related changes and can lead to annular tears, nuclear material changes, and instability. Later stages involve further disc resorption and replacement by fibrocartilage. Nerve fibers in the outer annulus can contribute to discogenic pain.
Lumbar spinal stenosis perhaps is understood best as a clinicopathologic disorder: narrowing of the lumbar spinal canal and the nerve root canals (causing central and lateral recess stenosis respectively) typically is brought about by the process of osteoarthritis and leads to compression of the contents of the canals the neural and vascular structures, causing neurologic symptoms (typically low back and leg pain and lower limb numbness and weakness) that are intermittent, characteristically triggered by ambulation (ameliorated by pausing), and generally positional (aggravated by standing and eased by trunk flexion).
Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
Abstract
Frequent Knee Locking is an incapacitating condition that requires a thorough clinical, radiological and arthroscopic evaluation. The common causes are meniscal injury followed by torn anterior cruciate ligament and osteochondral loose bodies in the joint space. Our case describes an unusual case of frequent left knee locking. After clinical and radiological examinations the provisional diagnoses of medial meniscus tear was done. A diagnostic arthroscopy of the left knee revealed normal meniscus, cruciates and a medial patello femoral plica slipping into the patellofemoral joint causing the locking sensation. The plica was resected. At 6 month follow up there is no recurrence of symptoms.
This document provides an overview of spasticity, including:
- Definitions and descriptions of spasticity and the underlying pathophysiology.
- Common causes of spasticity like cerebral palsy, stroke, multiple sclerosis, and spinal cord injury.
- Methods for assessing spasticity severity, including the Ashworth scale and pendulum tests.
- Goals and approaches for managing spasticity, which may involve eliminating triggers, non-pharmacological interventions, medications, and occasionally surgery.
This clinical commentary reviews evidence for abnormal scapular and clavicular kinematics in patients with various shoulder pathologies including impingement, rotator cuff tendinopathy, tears, instability, and adhesive capsulitis.
The majority of studies found abnormal scapular kinematics including decreased upward rotation and posterior tilt in patients with impingement and rotator cuff tendinopathy. However, findings were inconsistent regarding the direction and presence of deviations. Increased internal rotation and clavicular elevation were also commonly observed.
Limitations across studies include small sample sizes, varying measurement methods, and lack of consideration for factors like age, dominance and severity of shoulder pathology. Further research is needed to clarify discrep
Neuropathic arthropathy, also known as Charcot joint, is a condition characterized by progressive joint destruction and deformity caused by loss of sensation in the joints. It was first described in detail by Jean-Martin Charcot in 1868. The major theories for its pathophysiology are neurotrauma from repetitive micro-injuries without pain sensation, and neurovascular dysregulation leading to hyperemia and bone resorption. Diabetes is the most common cause. Imaging shows bone fragmentation, joint dislocation, and deformity. Treatment involves prolonged casting or bracing to immobilize joints during the acute inflammatory phase, followed by bracing and accommodative footwear. Later stages may require surgery.
This document provides information on congenital pseudarthrosis of the tibia (CPT), including:
- CPT is a nonunion of the tibia that develops spontaneously in early life and is associated with bowing of the tibia. It occurs more commonly in patients with neurofibromatosis type 1.
- Surgical treatment aims to completely excise fibrous tissue, correct deformity, stimulate bone healing, and properly fix bone fragments. Options include bone grafting, internal fixation, Ilizarov fixation, vascularized fibular grafting, and amputation in severe cases.
- Classification systems divide CPT into types based on clinical features and radiographic findings to help determine prognosis and guide treatment
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Charcot joint arthropathy and rehabilitation management
1. CHARCOT JOINT ARTHROPATHY AND
REHAB MANAGEMENT
Dr. Harshaand Popalwar
MBBS, MD,DNB, MNAMS, PGDHM, FDFM
Specialist Grade Two
Department of Physical Medicine and Rehabilitation
Safdarjung Hospital, New Delhi
2. DEFINITION
Charcot foot (i.e.neuropathic
osteoarthropathy) can be defined as a
noninfectious and progressive condition of
single or multiple joints characterized by joint
dislocation, pathologic fractures, and severe
destruction of the pedal architecture that is
closely associated with peripheral
neuropathy.
3. INTRODUCTION
The description of Charcot joints dates back to
1703 when neuropathic osteoarthropathy was
first described by W. Musgrave.
Jean-Martin Charcot a French neurologist is
credited for his work in 1868 for describing gait
anomalies of patients with syphilis (tabes
dorsalis).
Jordan, in 1936, was the first to describe a
relationship of diabetes to neuropathic
arthropathy
4. ETIOLOGY
Any condition resulting in decreased peripheral sensation, proprioception,
and fine motor control:
Diabetes mellitus neuropathy with Charcot joints in 1/600-700 diabetics.
Related to long-term poor glucose control.
Alcoholic neuropathy
Cerebral palsy
Leprosy
Syphilis (tabes dorsalis), caused by the organism Treponema pallidum
Spinal cord injury
Myelomeningocele
Syringomyelia
Intra-articular steroid injections
Congenital insensitivity to pain
Spina bifida
Peripheral nerve injury
Multiple sclerosis
Poliomyelitis
5. UNDERLYING MECHANISMS
Two primary theories have been advanced:
Neurotrauma throry: Loss of peripheral
sensation and proprioception leads to
repetitive microtrauma to the joint in question; this
damage goes unnoticed by the neuropathic
patient, and the resultant inflammatory resorption
of traumatized bone renders that region weak
and susceptible to further trauma. Indeed, it is
a vicious cycle. In addition, poor fine motor
control generates unnatural pressure on certain
joints, leading to additional microtrauma.
.
6. This micrtrauma produces intracapsular
effusions,ligamentous laxity,and joint
instability. With continued use of injured
extrimity,further degeneration ensues, which
results in a charcot joint
7. Neurovascular theory: Neuropathic patients
have dysregulated autonomic nervous
system reflexes, and de-sensitized joints receive
significantly greater blood flow. The
resulting hyperemia leads to increased
osteoclastic resorption of bone, and this, in
concert with mechanical stress, leads to bony
destruction.
8. In reality, both of these mechanisms probably
play a role in the development of a Charcot
joint.
9. The presence of sensory neuropathy renders the
patient unaware of the initial precipitating trauma and
often profound osseus destruction taking place during
ambulation.
The concomitent autonomic neuropathy with its
associated osteopenia and relative weakness of bone
predisposes it to fracture.
Capsular and ligamentous distension or rupture is
also a part of this process,leading to the typical joint
subluxations and loss of normal pedal architecture in
the classic rocker bottom charcot foot.
10. CLASSIFICATION OF CHARCOT ARTHROPATHY.
In 1966 Eichenholz proposed a classification of
Charcot joints which is broken down into three
distinctive stages.
Stage one, or the development stage, shows debris
surrounding the joints on x-ray. Stage one can
develop over a period of days to weeks and is merely
radiographic change that occurs in response to
unperceived trauma.
Stage two is the coalescence stage. In stage two,
the bone begins to heal with absorption of debris and
healing of large fracture fragments.
.
11. Stage three, often called the reconstruction or
reconstitution stage, notes a reduction in bone
turn over and reformation of stable bone
structure.
Stage 0 was added in 1999 by Sella and
Barrette to include patients who exhibit clinical
symptoms of Charcot arthropathy but have yet
to show radiographic changes
In clinical practice,the initial developmental
stage is considered active or acute, whereas the
coalescent and reconstructive stages are
considered to be the quiescent or reparative.
12. RADIOGRAPHIC FINDINGS
Radiologically, osteoarthropathy takes on the
appearance of severely destructive form of
degenerative arthritis.
Sanders and frykberg describe typical
neuropathic osteoarthropathy patterns of joint
involvement based on joint location in diabetic
patients. these patterns may exist independently
or in combination with each other as determined
through clinical and radiographic findings.
14. Pattern 1 encompasses atrophic changes or
osteolysis of the MTP and interphalangeal
joints with the characteristic sucked candy
appearance of the distal metatarsals.
Ten to thirty percent of the neuropathic
osteoarthropathies have been categorised in
various reports as pattern 1.
17. Pattern 2 involves lisfranc’s joint,typically with
the earliest clue being a very subtle lateral
deviation of the base of the second metatarsal
at the cunieform joint.
Once the stability of this ‘keystone’ is lost, the
loisfranc joint complex will often subluxate
dorsolaterally.
Fracture of the second metatarsal base allows
for greater mobility in which subluxation of other
metatarsals occur.
18. The rupture of the intermetatarsal and
tarsometatarsal ligaments plantarly will also
allows a collapse of the arch during normal
weight bearing,leading to the classic rocker
bottom deformity.
pattern 2 is the most common presentation in
clinical practice.
19.
20. PATTERN 3:MIDTARSAL AND
NAVICULOCUNIEFORM JOINTS
Pattern 3 incorporates changes within the
midtarsal joint with the frequent addition of
naviculocunieform joint.
Spontaneous dislocation of the talonavicular
joint with or without fragmentation
characterize this pattern.
21.
22.
23. PATTERN 4:ANKLE AND SUBTALAR JOINT.
It involves the ankle joint, including the subtalar
joint and body of the talus.
Massive osteolysis is frequently observed in
this pattern with attendent ankle or subtalar
subluxation and angular deformity.
Tibial or fibular malleolar fracture are frequently
seen in association with osteoarthropathy in
this location and most likely precipitate the
development of the joint dissolution.
It is found in approximately 10 % of reported
cases.
24.
25.
26. PATTERN 5: CALCANEUS (CALCANEAL
INSUFICIENCY AVULSION FRACTURE)
It is least common presentation and is
characterised by extraarticular fracture of the
calcaneus.
This is more appropriately considered a
neuropathic fracture of body or,more
commonly,the posterior tuberosity of
calcaneus.
27.
28. CLINICAL PRESENTATION
Clinical features of acute charcot joint-
1.vascular- a) bounding pulse
b) erythema
c) swelling
d) warmth
2.neuropathic- a) absent or diminished:
pain, proprioception, deep tendon reflexes.
29.
30. 3) skeletal- a) rocker bottom deformity
b) medial tarsal subluxation
c) digital subluxation
d) rearfoot equinovarus
e) rearfoot subluxation
f) hypermobility
4) cutaneous- a) neuropathic ulcer
b) hyperkeratosis
c) infection
32. CLINICAL DIAGNOSIS OF ACUTE CHARCOT
ARTHROPATHY
Plain radiographs are invaluable for
ascertaining the presence of
osteoarthropathy in a warm, swollen,
insensate foot.
With a concomitant wound, it may initially be
difficult to differentiate between acute charcot
arthropathy and osteomyelitis solely based
on plain radiographs.
33. When ulcer probes to bone, a bone biopsy
is indicated and should be considered most
specific method of distinguishing between
osteomyelitis and charcot arthropathy.
A biopsy consisting of multiple shards of
bone and soft tissue embeded in the deep
layers of synovium is pathognomic for
neuropathic osteoarthropathy.
34. Tecnetium bone scan- expensive and
nonspecific to differentiate between
osteomyelitis and charcot arthropathy.
Indium scanning still expensive,but has been
shown to be more specific.
35. CONSERVATIVE MANAGEMENT.
Immobilization and reduction of stress are
considered the mainstay of treatment for
acute charcot arthropathy.
Non weight bearing on the affected limb for 8-
12 weeks removes the continual trauma and
should promote conversion of the active
charcot joint to the quiescent phase.
36. OFF-LOADING OR IMMOBILIZATION DEVICES
USED IN THE MANAGEMENT OF CHARCOT FEET.
-wheelchai
-crutches
-walker
-Elastic bandage or jones dressing
-unna’s boot
-total contact cast
-fixed ankle walking brace
-Posterior splint
-patellar tendon-bearing brace
-charcot restraint orthotic walker (CROW)
-surgical shoe with custom inlay
37. Off loading with or without immobilization
should be anticipated for approximately 3-6
months, depending on the severity of joint
destruction.
When the patient enters quiescence phase,
management is directed at a gradual
resumption of weight bearing with prolonged
or permenent bracing.
38. Care must be taken to wean the patient
gradually from non-weight bearing to partial
to full weight bearing with the use of assistive
devices.
Charcot restraint orthotic walker(CROW) or
other similar total contact prosthetic walkers
have gained acceptance as useful protective
modalities for the initial period of weight
bearing.
39. Feet must be closely monitored during the
time of transition to permanent footware to
ensure that the acute inflammatory process
does not recure.
Forefoot and midfoot deformities (patterns 1-
3) often do well with custom full length
inserts and comfort or extra depth shoes
once bracing is no longer required.
40. Severe midfoot deformities will often require the
fabrication of custom shoes to accommodate
the misshapen foot.
Rearefoot osteoarthropathy with minimal
deformity may require only a deep, well
cushioned shoe with a full-length orthotic
device.
For mildly unstable ankles without severe
deformity or joint dissolution,high-top custom
shoes can sometime provides adequate stability
against transverse plane rotational forces.
41. The moderately unstable ankle will benefit
from an ankle foot orthosis(AFO) and a high-
top therapeutic shoe.
The severely unstable or maligned rearfoot
will require a patrllar tendon-bearing (PTB)
brace incorporated into a custom shoe.
45. MEDICAL MANAGEMENT
Control of sugar in diabetic patient
Management of infection with antibiotics
In the setting of altered bone mineral density
(BMD) in patients with diabetes,
bisphosphonates can be use to prevent
further osteoporosis in charcot arthropathy.
46. SURGICAL THERAPY
Neuropathic arthropathy should not be considered
primarily a surgical disorder.
Surgery should be contemplated only when attempts
at conservative care have failed to provide a stable,
plantigrade foot.
instability, gross deformity,and progressive
destruction despite immobilization are the primary
indications for surgical intervention.
Procedures such as simple bone resections,
osteotomies, midfoot or major tarsal reconstraction,
and ankle arthrodesis might become necessary.
47. Amputations should usually be regarded as a
procedure of last resort in neuropathic
patients and not as a normal consequence of
osteoarthropathy.